Organization
WMC CLINIC
Active
Organization
WMC CLINIC
Active
Parent organization
BANNER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER HEALTH
Authorized official
DENNIS DAHLEN (SR VICE PRESIDENT FINANCE)
(602) 747-4000
Entity
Organization
Contact information
Practice address
1405 HOWELL AVE, WORLAND, WY 82401-4127
(307) 347-2555
(307) 347-2597
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118243900
—
WY
Enumeration date
06/30/2006
Last updated
01/19/2009
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